Category · F10-F19 block
F10 — Mental and behavioural disorders due to use of alcohol
Terminology note: "Alcoholic" is a colloquial label that does not map cleanly onto any single ICD-10 code and is avoided here. The classification distinguishes harmful use (F10.1) from dependence syndrome (F10.2) by specific criteria, not by how much someone drinks or how the drinking is socially judged.
What is this category?
F10 is the anchor category for this block: alcohol is the substance against which the shared ten-state framework (see the block orientation page) is most fully taught, because alcohol dependence and withdrawal are both extremely common in general clinical settings and genuinely medically dangerous. Every other category in this block reuses the dependence-syndrome and withdrawal-state concepts introduced here, applied to a different substance.
Core diagnostic concept
The classification question F10 most often turns on is not "does this person drink a lot?" but "has alcohol use produced a specific cluster of features — a strong desire to drink, difficulty controlling it, tolerance, a physiological withdrawal state, neglect of other interests, and continued drinking despite clear harm — occurring together, typically over the past year?" That cluster is dependence syndrome (F10.2). A pattern of drinking that is damaging health but does not yet show that cluster is harmful use (F10.1) — a distinct, lower threshold, not an earlier stage automatically implied by heavy drinking alone.
Key diagnostic features
- Strong desire or compulsion to drink
- Often described by the person as craving — a subjective pull toward drinking that can feel difficult to resist, distinct from simply enjoying alcohol.
- Difficulty controlling use
- Difficulty controlling the onset, termination, or level of drinking — for example, intending to have one drink and repeatedly finding that intention fails.
- Physiological withdrawal state
- Symptoms (tremor, sweating, anxiety, nausea, in severe cases seizures or delirium) on reducing or stopping drinking, or drinking specifically to relieve or avoid those symptoms.
- Tolerance
- Needing clearly increased amounts of alcohol to achieve the effect originally produced by lower amounts.
- Progressive neglect of alternative interests
- Increasing time and priority given to obtaining, using, and recovering from alcohol, at the expense of other pleasures or responsibilities.
- Continued use despite clear harm
- Persisting with drinking despite awareness of physical, psychological, or social harm it is causing.
How to weigh evidence
These learning labels are teaching aids, not official ICD-10 terminology (see Sources and Method).
- supports Drinking increasing amounts over a year, morning shaking relieved by a drink, and missed work commitments the person still cannot cut back on.
- consistent not decisive The person drinks daily. Frequency alone does not establish dependence without the broader criteria cluster.
- raises alternative Health has clearly worsened (fatty liver on recent tests) from drinking, but there is no reported difficulty controlling intake and no withdrawal symptoms — this points toward harmful use (F10.1) rather than dependence.
- contradicts or weakens The person has cut down without difficulty on several occasions when they chose to, with no withdrawal symptoms reported.
- missing and necessary to ask Whether the person has ever tried to cut down and, if so, what happened when they did.
Diagnostic boundary
F10 is distinguished from harmful use by whether the fuller dependence cluster (not just health damage) is present, from F13 by cross-tolerance and pharmacological similarity but a separate substance identity, and its withdrawal-with-delirium state (F10.4, delirium tremens) from delirium of other causes (F05, which explicitly excludes alcohol-induced delirium) by the clear temporal link to alcohol reduction or cessation.
Full comparisons:
Duration and course
Minimum duration: Dependence syndrome is typically established when three or more of the six criteria have been present together at some time during the previous year.
Course: Withdrawal symptoms typically begin 6-24 hours after the last drink, commonly peak around 24-72 hours, and delirium tremens (F10.4) — when it occurs — typically peaks somewhat later, around 48-96 hours after cessation.
Included presentations
- A pattern meeting three or more dependence-syndrome criteria within the past year.
- A pattern of drinking causing demonstrable physical or psychological harm without meeting the fuller dependence cluster (harmful use).
- Withdrawal symptoms, including the more severe withdrawal-with-delirium presentation, temporally linked to reducing or stopping a sustained heavy drinking pattern.
Exclusions and distinguishing presentations
| If this is true instead… | Consider | Why |
|---|---|---|
| A similar dependence/withdrawal pattern where the substance is a prescribed or non-prescribed sedative or hypnotic rather than alcohol | F13 | Sedatives and hypnotics share cross-tolerance and a comparably dangerous withdrawal course with alcohol, but are classified under their own category. |
| Delirium with no temporal link to alcohol reduction or cessation | delirium consciousness | Delirium tremens (F10.4) requires a clear link to stopping or reducing sustained heavy drinking; delirium from another cause should be actively considered. |
| Persisting psychotic symptoms better explained by an independent psychiatric illness than by alcohol | independent psychiatric illness capsule | Alcoholic hallucinosis and other alcohol-related psychotic presentations should be distinguished from an independent psychotic illness that happens to co-occur with heavy drinking. |
Four-character subtypes (orientation)
A learner should not assign the withdrawal-with-delirium or amnesic-syndrome subtypes from a single symptom (confusion, memory complaints) without checking timing and the full clinical picture. These subtypes are taught here for orientation only and are not separately assessed in this pilot; F10.1, F10.2 and F10.3 are the assessed states.
- F10.0 — Acute intoxication
- Transient state during or shortly after drinking — disinhibition, slurred speech, incoordination — resolving as alcohol is cleared. (taught for orientation only, not separately assessed in this pilot)
- F10.1 — Harmful use
- A pattern of drinking causing demonstrable physical or psychological harm, without the fuller dependence-syndrome cluster. (in_depth)
- F10.2 — Dependence syndrome
- Three or more of the six dependence criteria present together within the past year. (in_depth)
- F10.3 — Withdrawal state
- Symptoms (tremor, sweating, anxiety, nausea) on reducing or stopping sustained heavy drinking. (in_depth)
- F10.4 — Withdrawal state with delirium
- Withdrawal complicated by delirium — delirium tremens — a medical emergency. (taught for orientation only, not separately assessed in this pilot)
- F10.5 — Psychotic disorder
- Psychotic phenomena occurring during or immediately after heavy drinking, not fully explained by intoxication alone. (taught for orientation only, not separately assessed in this pilot)
- F10.6 — Amnesic syndrome
- Prominent, chronic impairment of recent memory with relatively preserved immediate recall — the classic Korsakoff-type presentation. (taught for orientation only, not separately assessed in this pilot)
- F10.7 — Residual and late-onset psychotic disorder
- Alcohol-related cognitive, affective, personality or behavioural changes persisting beyond the period of direct alcohol action. (taught for orientation only, not separately assessed in this pilot)
- F10.8 — Other mental and behavioural disorders
- An alcohol-related presentation not fitting the other listed states. (taught for orientation only, not separately assessed in this pilot)
- F10.9 — Unspecified mental and behavioural disorder
- An alcohol-related disturbance identified but without enough information to classify further. (taught for orientation only, not separately assessed in this pilot)
External causes to check first
Categories in this block require that the disturbance is not better explained by another external cause listed below. These short capsules are reminders, not full teaching modules.
External cause capsule — Considering an independent psychiatric illness
A reminder that a psychotic (or other psychiatric) presentation occurring alongside substance use should not automatically be assumed substance-induced — an independent illness should be actively considered when the evidence points that way, before settling for an F1x subtype as the final answer.
What to check:
- Persistence: has the presentation continued essentially unchanged well beyond that substance's expected substance-induced resolution window despite confirmed abstinence, rather than gradually resolving?
- Trajectory: is the picture static or worsening despite abstinence, rather than the gradual improvement typically expected of a resolving substance-induced disorder?
- History: is there a personal or family history of psychotic or other psychiatric illness that would raise the prior likelihood of an independent illness?
- Onset: did any psychiatric symptoms clearly predate the substance use in question, which would argue against a purely substance-induced explanation?
A full differential workup distinguishing a resolving substance-induced disorder from an emerging independent illness, which requires assessment beyond what a single vignette can establish — the honest classification-reasoning answer is often "consider an independent illness" rather than a fully certain diagnosis in either direction.
External cause capsule — Delirium and disturbances of consciousness
A reminder to distinguish a disturbance of consciousness and attention (delirium) from a primary psychotic disorder, since delirium can present with hallucinations and delusion-like beliefs.
What to check:
- Level of consciousness and attention: delirium involves fluctuating, reduced clarity of awareness and impaired attention, which is not a feature of F20-F29 categories.
- Time course within a day: delirium symptoms characteristically fluctuate over hours, often worse at night, whereas F20-F29 presentations are typically more stable across a day.
- An identifiable acute medical trigger (infection, metabolic disturbance, medication effect, withdrawal) is common in delirium.
- Onset: delirium is usually acute (hours to days), which should also prompt consideration of F23 versus a purely medical explanation.
A full teaching module on delirium and organic mental disorders (F00-F09), which is outside this pilot's scope.
Common learner errors
Worked example — separating harmful use from dependence syndrome
A 42-year-old office manager has been drinking six to eight beers most evenings for the past 18 months, up from two or three a year earlier. He has tried to cut down twice this year, both times finding he drank more than intended within a few days. On mornings after heavier drinking he notices his hands shake until he has a drink, which settles it. He has missed two family events recently because he was drinking instead, though he says he still values his family highly. Recent blood tests show mildly raised liver enzymes.
- Step 1 — Check for tolerance: he now drinks more than double his amount from a year ago to get a similar effect, meeting the tolerance criterion.
- Step 2 — Check for a withdrawal state: morning shaking relieved specifically by drinking suggests a physiological withdrawal state, a second criterion.
- Step 3 — Check for difficulty controlling use: two failed attempts to cut down, despite intending to, meets a third criterion.
- Step 4 — Check for neglect of alternative interests: missing family events he says he still values, in favour of drinking, supports a fourth criterion.
- Step 5 — Weigh against harmful use alone: the raised liver enzymes show physical harm, but harm alone would only support F10.1 — here it is one part of a broader cluster, not the whole picture.
- Conclusion — With four criteria present together within the past year (well past the three-criterion threshold), this is best classified as dependence syndrome (F10.2), not harmful use, because the fuller cluster — not just health damage — is demonstrated.
Interactive practice
- Type A More than just heavy drinking? Recognition / application · Foundation
- Type B Shaking hands, familiar pattern — but which substance? Boundary / differential · Boundary
- Type C How worried should we be about this withdrawal? Insufficient information · Developing
Retrieval prompts
Try answering each of these from memory before revealing where to check. Nothing you think or type here is sent or saved anywhere.
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Without looking back at the page, name three of the six dependence-syndrome criteria.
Reveal answer location
Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.
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State the one feature that separates harmful use from dependence syndrome.
Reveal answer location
Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.
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Explain in one sentence why frequency or quantity of drinking alone cannot establish dependence.
Reveal answer location
Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.
These self-checks are a personal study aid only, visible to you on this page for this visit — they are not stored and do not affect your mastery dimensions.
Rapid revision card
F10: A cluster of features — desire, control difficulty, tolerance, withdrawal, neglect of alternatives, continued use despite harm — with three or more present together in the past year, distinguishes dependence syndrome from harmful use (health damage alone) or simple heavy drinking.
Decisive boundary cues:
- Difficulty controlling use plus tolerance plus withdrawal -> weighs toward F10.2 dependence over F10.1 harmful use.
- Health damage alone, with no control difficulty or withdrawal -> weighs toward F10.1 harmful use.
- Delirium with a clear link to stopping/reducing drinking -> F10.4, not an unrelated delirium (F05).
Duration/course: Three or more dependence criteria present together within the past year; withdrawal onset typically 6-24 hours after the last drink.
Nearest alternatives: F13, F05
Common mistake: Treating heavy or frequent drinking itself as proof of dependence, without checking for the fuller criteria cluster.
Retrieval prompt: What single question would you ask first to separate harmful use from dependence syndrome in this case?
(or use your browser's print function) Open full-page printable revision view →
Related glossary terms
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Dependence syndrome
A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use, in which use of that substance takes on a much higher priority than other behaviours that once had greater value. Classically established when three or more of six criteria (strong desire/compulsion, difficulty controlling use, tolerance, a physiological withdrawal state, progressive neglect of alternative interests, and continued use despite clear harm) have been present together within the past year.
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Harmful use
A pattern of psychoactive substance use that is causing demonstrable damage to physical or mental health, without meeting the fuller criteria cluster required for dependence syndrome. A distinct threshold from dependence, not merely a lesser degree of it.
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Tolerance
A state in which increasing amounts of a substance are needed to achieve the effects originally produced by a lower amount, or in which continued use of the same amount produces a markedly diminished effect. One of the six criteria contributing to a dependence-syndrome classification.
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Withdrawal state
A group of symptoms, of variable severity and clustering, occurring on absolute or relative withdrawal of a substance after repeated, and usually prolonged and/or high-dose, use of that substance. Onset, timing, and medical danger vary considerably by substance.
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Craving
A strong subjective desire or compulsion to use a substance. One of the six criteria contributing to a dependence-syndrome classification, and often prominent during withdrawal as well.
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Delirium tremens
The classic name for alcohol withdrawal state with delirium — a short-lived but potentially life-threatening confusional state, usually accompanied by marked tremor, autonomic overactivity, and sometimes vivid hallucinations or delusions, occurring on withdrawal from sustained heavy alcohol use.
Source basis
WHO ICD-10 international classification structure and code/title (ICD-10 Browser, 2019 English release).
Original educational synthesis, informed by general published clinical-education understanding of ICD-10 F10 and the general dependence-syndrome/harmful-use criteria; no verbatim CDDG or DCR text is reproduced. See Sources and Method for the full policy.
Last reviewed: 2026-09-15. Full policy: Sources and Method.
Educational resource only. This page and its cases teach ICD-10 classification reasoning using fictional scenarios. It does not diagnose real people and should not be used to assess yourself or anyone else. If you are worried about your own or someone else's alcohol or drug use, please speak with a qualified health professional.